John Theurer Cancer Center - Gold Standard of Care

The mission of the John Theurer Cancer Center is to deliver extraordinary care that is multidisciplinary, personalized, innovative, and at the appropriate cost with superior outcomes to the most satisfied patients. That’s a tall order, but it seems that the center is fulfilling its mission. The John Theurer Cancer Center at Hackensack University Medical Center in New Jersey was ranked as one of the top 50 Best Hospitals for cancer, according to U.S. News & World Report. It is the highest-ranked cancer center in New Jersey with this designation. Within its 14 specialized cancer divisions, world-class physicians, nurses, and scientists have harnessed the newest technologies

to serve the patients who come through its doors. The Oncology Nurse-APN/PA spoke with Melinda Weber, RN, APN, about what it is like to work at the John Theurer Cancer Center.

What is your role at the John Theurer Cancer Center?
Melinda Weber (MW): I am the advanced practice nurse manager. I wear many hats. First and foremost, my managerial responsibilities focus on collaboration with my immediate team of advanced practice nurses, educators, and nurse navigators. I also work “in the trenches” with my administrative, financial, ancillary, legal, pharmacy, radiation, laboratory, dietary, psychosocial, and physician team to achieve the best possible outcomes for our patients and the institution. This includes maintaining compliance with JCAHO [Joint Commission on Accreditation of Healthcare Org­a­nizations], ACS [American College of Surgeons], Magnet, and all national accrediting agency mandates and licensure requirements.

Additionally, I maintain all day-to-day activities of the all-division–specific advanced practice nursing team, with emphasis on scheduling all areas for patient safety outcomes. I also cover the solid tumor division when needed as a “float” to act in a clinician capacity to ensure patient care. I am also the clinical advanced practice nurse for the Skin and Sarcoma Division and act as a direct patient caregiver for the division.

What are you excited about right now in the field of oncology?
MW: I am very excited about value-based medicine. We are providing the appropriate individualized gold standard of care that meets and exceeds all national standards, whether diagnostic or therapeutic, without the need for undue diagnostic studies or redundant, unwarranted interventions. This ap­proach is critical, not only because of our current healthcare economy, but because of quality and ethical issues as well.

I am also very enthusiastic about evidence-based practice and its applicability to oncology. We have created evidence-based guidelines for toxicities and adverse events such as nausea/vomiting, diarrhea, and mucositis. We have developed written guidelines/order sets on a single page via NCI [National Cancer Institute] standards using the Common Terminology Criteria for Adverse Events to grade toxicities; provide an immediate teaching tool for patients about that toxicity; and suggest the immediate evidence-based gold standard inter­vention for that toxicity. We are working on building this 1-page tool into the electronic medical record for all patients who are treated at our center and throughout the entire medical center as well. This will enable any practitioner who is seeing that patient to access the entire record of toxicities and interventions for that patient.

What is the approach to treating patients at the John Theurer Cancer Center?
MW: Our goal is to provide comprehensive, individualized extraordinary care for every patient. Throughout our 14 cancer divisions, we employ a multidisciplinary approach with medical oncologists, surgeons, nurse navigators, clinical nursing staff, advanced practice nursing team, patient navigators, other specialty physicians, social workers, and support staff. We offer complimentary yoga, exercise, and cooking classes. We have a librarian who provides complimentary literature searches for patients. We are committed to clinical research, including phase 1 trials, working today to provide tomorrow’s cures. We also have an active tumor bank of blood and tissue samples for personalized cancer therapy development. We have one of the nation’s largest blood and bone marrow transplant programs. We offer “TrueBeam”-specific radiosurgery, and TomoTherapy radiation, as well as da Vinci surgical robots.

How does your approach improve patient outcomes?
MW: All of our physicians are board- certified oncology experts. Each division actively participates in multidisciplinary tumor boards, presenting patients to determine the best plan of care. We are certified by ACS; JCAHO, including DSC [disease-specific care] certification for our Breast, Gynecology, Gastro­intestinal, and Bone Marrow Transplant programs; and are Magnet certified as well. We follow NCCN [National Com­prehensive Cancer Network] guidelines, and patients have access to evidence-based clinical care. For example, today my physician colleague and I consulted with a new patient with breast cancer and incidentally discovered a spot on her lung. Her pathology slides from a previous institution were reviewed the same day, with additional pathology markers ordered, and she was immediately referred to our lung cancer expert and pulmonary care expert. She received individualized patient education, and, after we obtained insurance authorization, she received her diagnostic scans the same day as her consult, and her plan of care was created.

What inspired you to become an oncology nurse?
MW: As a junior volunteer, I worked with a very young patient who was dying of metastatic pancreatic cancer. I was deeply touched by the level of compassion and dignity provided by the oncology nurses.

What advice would you give to nurses just entering the field?
MW: Select the best baccalaureate and graduate nursing program you can find, and be sure you are in an environment that fosters love of learning. After nursing school you will continue to learn, because the field of cancer is constantly evolving, and what was considered the best care management 5 years ago has changed dramatically. Be sure to network with great colleagues. The Oncology Nursing Society is a guiding light for every oncology nurse and offers a bastion of opportunity for networking and also for certification. For me, the most important principles of oncology nursing are intelligence, diligence, grace, and humility. To be kind, respectful, and approachable to patients, their significant others, and our entire team is absolute. We need to be agents of change. Remember, a genuine smile goes a long way for someone with cancer.

What would you be if you were not an oncology nurse?
MW: A stand-up comedian.